Police revealed Tuesday that at least some of the images were captured with a camera hidden in the top of a pen, and authorities were exploring whether the recordings had been distributed. The doctor, Nikita A. Levy, was found dead of an apparent suicide Monday.

Police are treating the case as an open criminal investigation, and the Johns Hopkins board of trustees has opened a separate inquiry.

The extent of the legal fallout remains to be seen. Whether Hopkins, insurers or others could be held liable for the doctor's actions depends on whether there is any evidence of negligence, according to legal experts. And claims of privacy breaches may hinge on whether the women can be identified in the images and what they show, the experts said.

Hospitals have been held liable for failing to protect patients' privacy in past cases, ranging from revealing personal medical information to abuse. A Connecticut hospital settled in April for about $50 million with 150 victims of an endocrinologist who used a medical study as a pretense to take obscene photographs of children.

Baltimore police are seeking to interview patients who saw Levy over more than two decades. He practiced gynecology and obstetrics through a Hopkins network of physicians, mainly at the East Baltimore Medical Center, a community clinic near Johns Hopkins Hospital. He had worked for Hopkins since 1988, the same year he received his Maryland medical license.

A colleague reported the allegations to Hopkins officials on Feb. 4, and Levy was let go Feb. 8, according to the hospital. Officers had been scheduled to meet with Levy in the week after his dismissal, but he did not show up, city police spokesman Anthony Guglielmi said. Before they could reschedule, he was found dead in his Towson home, Guglielmi said.

An autopsy was performed on Levy's body Tuesday, but the cause and manner of death had not yet been determined, Baltimore County police spokeswoman Cathleen Batton said.

Baltimore police uncovered what they called an "extraordinary" amount of evidence at Levy's Towson home but would not say when the search occurred. Police are working with federal officials to analyze the evidence, Guglielmi said.

Officers established a hotline for Levy's patients and anyone with information for the investigation, at 410-396-2269. Hopkins officials set up their own call center at 855-546-3785.

One patient, who wished to remain anonymous because of the embarrassing nature of the allegations, said she called the Hopkins line Monday and was told that little information could be provided because the investigation was ongoing. She was told to call police and eventually reached sex crimes detectives.

"They just took my information down and said the investigation was in process," she said.

Hopkins officials declined to answer questions or release any new information beyond a statement issued Monday. The statement called any invasion of patient privacy "intolerable," apologized to the patients and said medical system trustees would launch an independent investigation into the allegations. Hospital officials also said they would send letters to patients this week.

Lawyers said they began receiving calls from concerned women, too. Andrew Slutkin, a lawyer with Silverman Thompson Slutkin & White in Baltimore, said his law office talked with two of Levy's former patients.

In any civil case, the potential victims would have to prove they are the ones shown in the images, lawyers said. It's possible that if faces aren't shown, other information like time stamps on digital recordings could be used in circumstantial arguments, said Gregory Dolin, co-director of the Center for Medicine and Law at the University of Baltimore.

"If someone takes a photo of someone's foot or private part, it's hard for the person whose picture was taken to prove that was done," Dolin said.

Another expert spoke on the difficulties posed by identification.

"If someone cannot be identified, they can't very well make the case they were embarrassed or humiliated," said Darren McKinney, communications director for the American Tort Reform Association in Washington, D.C.

In similar cases involving large numbers of patients, lawyers have sued the medical institutions and insurance companies because collecting big-dollar damages from doctors or their estates can be difficult, lawyers said. That can require proof the institution was negligent and could have prevented the invasion of privacy, said McKinney.

"Was there any inkling from colleagues? Were they even aware of rumors?" McKinney said.

Such cases can depend on whether a judge or jury determines that the illegal actions were done within the "scope of employment" and that the employer should be held liable for an employee's actions, Slutkin said.

"Even if an act is willful, reckless or criminal, so long as a person acts within the scope of their employer or in furtherance of business, the employer is liable," Slutkin said.

The legal concept, which dates to the Middle Ages and the days of servants acting on behalf of their masters, requires consideration of how the illegal actions relate to an employee's normal duties, Dolin said.

St. Francis Hospital in Hartford, Conn., settled with about 150 patients last year for about $50 million after one victim was awarded $2.75 million in a 2011 trial. The case revealed that endocrinologist George Reardon had launched what he called a long-term pediatric growth study as a pretext for photographing children posed obscenely, sometimes in groups.

Hartford attorney Richard Kenny, who represented 43 of the victims, said while they found no evidence that hospital officials knew of Reardon's activities, documents showed that those officials were required to police and review research activity. Lawyers argued in court that the hospital failed to follow its own internal rules and regulations, Kenny said.

"You need to be able to present a claim of negligence against the institution," Kenny said. "That's the only way to get insurance to trigger."

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